The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis

Quirino Lai,Gianluca Mennini,Francesco Giovanardi,Massimo Rossi,Giammauro Berardi

doi:10.1007/s13304-021-01160-x

Abstract

Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.

Highlights

The considerable progress made in conventional liver surgery and the experience gained from technical variants of whole liver transplantation consented to develop the first living-donor liver transplantation (LDLT) experiences [1, 2]
The specific research question formulated in this study includes the following components of PICO: Patient: ann individual undergoing right hepatectomy for A2ALDLT; Intervention: right hepatectomy performed with minimally invasive liver resection (MILR); Comparison: right hepatectomy performed with open liver resection (OLR); Outcome: duration of surgery/intraoperative blood loss/ post-operative transaminases peak/any post-operative complication/post-operative Dindo-Clavien complication ≥ IIIa/ duration of post-operative hospitalization
As a further confirmation of this evidence, the recent guidelines published on MILR and liver donation stated that “pure laparoscopic” donor hepatectomy is applicable to left lateral sectionectomy and should be considered standard practice once the team has fulfilled the adequate learning” [11]

Summary

Introduction

The considerable progress made in conventional liver surgery and the experience gained from technical variants of whole liver transplantation consented to develop the first living-donor liver transplantation (LDLT) experiences [1, 2]. Mainly in the specific setting of adult-toadult (A2A)LDLT, several concerns were raised in terms of donor safety [3]. These obstacles were successfully overpassed in Asian countries, where the problem of deceased donation shortage was critical due to religious and cultural issues [4]. A2ALDLT remains a challenging procedure, mainly when the right hepatic lobe is donated. This datum explains why, especially in Western countries, the medical community still considers the right hemi-liver donation as a “risky procedure” to be performed with caution and under certain conditions [7]. With the intent to minimize the risks of donation, the use of a minimally invasive liver resection (MILR) approach for liver donation has been postulated

Methods

Results

Conclusion